Impact of targeted lower-limb exercises on biomechanical and neuromuscular risk factors associated with medial tibial stress syndrome.

Medial Tibial Stress Syndrome (MTSS) is linked to biomechanical risk factors such as high tibial loading, often influenced by underlying motor control strategies. Active interventions utilising multiplanar loading to retrain motor control may reduce tibial loading, yet their effects remain unclear, particularly whether they induce fatigue or beneficial potentiation. This study randomised 20 active individuals to single-leg lateral hops (SLLH) or controlled step-downs (CSD) interventions. Kinetic, kinematic, and electromyographic adaptations were assessed via a standardised jump-landing task executed pre- and post-intervention. Post-SLLH, the dominant leg exhibited a compliance shift, with reductions in loading rate (-21.4%; p = 0.004) and impulse (-16.1%) coupled with increased knee flexion range of motion. The non-dominant leg demonstrated enhanced neuromuscular efficiency, showing improved postural stability (centre of pressure displacement: -19.0%; p = 0.032) Coupled with reductions in muscle activation (Tibialis Anterior AUC: -35.8%; p = 0.004). Controlled step-downs elicited localised proximal control changes, including increased hip flexion, but did not alter kinetic impact factors. These findings suggest SLLH acts as a potentiating neuromuscular primer that reorganises motor control into limb-specific strategies of mechanical compliance and neural efficiency, positioning it as a superior method for influencing MTSS risk factors.